Objective To study the diagnoses and treatments of small thyroid nodules (maximum diameter ＜ 1 cm) with contralateral papillary thyroid microcarcinoma (PTMC).Methods A total of 253 patients with unilateral PTMC and contralateral thyroid benign nodules identified by ultrasound before thyroidectomy was retrospectively analysed. All patients underwent near-total or total thyroidectomy.Chisquare test was used for univariate analysis and logistic regression test for multivariate analysis.Results In 53(20.9％ ) of 253 patients with unilateral PTMC,the contralateral thyroid benign nodules identified by ultrasound were confirmed pathologically as PTMC.Univariate analysis showed multifocality of the primary tumor and Hashimoto's thyroiditis were correlated with contralateral PTMC (x2 =24.834,x2 =5.182,P ＜0.05 ).However,there were no significant differences for the existence of contralateral PTMC in age,sex,tumor size,capsule invasion,lymph node metastasis,the number of nodules and Tg-level. Multivariate analysis showed only multifocal PTMC was an independent predictive factor for contralateral PTMC ( OR =5.352,P ＜ 0.05 ).Conclusions The patients with unilateral multifocal PTMC have a high rate of PTMC in contralateral small thyroid nodules.However,it is very difficulty to define by ultrasonography preoperatively.The total thyroidectomy maybe serve as a useful treatment.%目的 总结单侧甲状腺微小乳头状癌(papillary thyroid microcarcinoma,PTMC)合并对侧甲状腺小结节(最大径＜1 cm)患者的临床特点及处理方法.方法 回顾性分析253例单侧PTMC对侧腺叶合并有术前B超诊断为良性小结节患者的临床资料.253例患者均行甲状腺一侧腺叶切除、对侧近全切除或全切除术.对患者相关临床特征采用x2检验进行单因素分析,采用Logistic回归进行多因素分析.结果 53例(20.9％)患者对侧小结节术后病理诊断为PTMC,其余200例(79.1％)为良性结节.单因素分析发现,对侧结节PTMC发生与合并桥本甲状腺炎和一侧多发癌灶有关(x2=24.834,x2=5.182,P值均＜0.05),与年龄、性别、病灶大小、被膜侵犯、淋巴转移、结节数量及甲状腺球蛋白水平无关.多因素分析显示只有一侧多发癌灶是对侧结节PTMC发生的独立危险因素(OR=5.352,P＜0.05).结论 甲状腺多发小结节患者若一侧为多灶性的PTMC,对侧小结节发生B超难以分辨的PTMC的概率较高,宜采取甲状腺全切除术的治疗策略.
展开▼
